Method for testing the physical condition of human beings



Sept. 12, 1933. F, MacKENzlE r AL 1,926,748

METHOD FOR TESTING THE PHYSICAL CONDITION OF HUMAN-BEINGS Filed.Aprl 27 YThis invention is lan improvementin methodsk Patented Sept. 1.2, l1931? A I TES c n A` 1,926,7481" METHOD non"` ."rEsTING YTHE PATENT oFFicfE rirrsrmlnA i CONDITION OFHUMAN BEINGS Lewis F, MacKenzie, Newark, ,Philip V. Wells,`

Princetcn, f and yEdwin Park, N; J.y y

G. Dewis, Asbury Y,

Application' April 27, 1929.- sel-il No. 358,660V

, s Claims. v(C1. 12s-2).'

for the study of physical eiciency; rit isl especially ladapted for enablingthe individual under test to blow at a constant rate and at a standard in- Vtrapulmonary pressure, both rate ,and pressure so chosen that the blood-pressures rise `considere ably above theirnrestfvalues before the nsubject feels compelled to stop-blowing. The apparatus of the invention, therefore, may be called a fiarimeter, from .the Latin `verb flare-ftd blow.4 The kiiarimeter provides a convenient methodv of( subjecting the circulatory and respiratory systems to. accurately controlled conditions such thatv the responses in the systolic and in the ,diastolic pressures, in the pulserate and the duration of the blow, may be used to measure the functional efficiency of the circulation. Thev apparatus lof the invention is, more particularly "claimedin our-jU, jS. Patentk 1,857,732, dated May TheI flarimeter is designed torcontrol the type,

. magnitude and` durationvofthe physical effort, to

cause therbloodfpressuresto riserslowlybutsufciently for the Vexaminer to observe the maximum systolic andi diastolic n pressuresthe Y pulse rate and the total lengthof the blow with. accuracy and ease. c The rapparatus'is simple, durable-,re-`

producible, and inexpensive inconstruction, .so thatthe method is especially adaptedto the conV ditions `c fmedical practice. c c A,

"Ihefmeasurement of the syston'c and diastolic pressures andthe lpulserateof an individual at resty may suggest certain pathological conditions in the circulatory system, but important addi-A-VV tional information isV given by theirk response when the'circulation .is *under load. Muscular exercises, suchas bending, ascending. a flight of` stairs, lifting weights, etc., are often used for this purpose, but such effortis diiicult` to standardize and is not always available Yor convenient. Forced expiration (after full inspiration) v'provides ,the most convenient means of placing the circulatory system under a standard load, To producesuiie cient responses in systolic and diastolic pressures, however, the rate `of. expiration must be 'controlled so as to produce a cumulative effect-' VIt is only in the latterstages of the-,sustained ex-V piration that the systolic .and diastolic lpressures rise Yconsiderably `above theirzvalues when ythe subject is at rest.V If the expiration is too Arapid or` toorslow the responseis notas pronounced as it isA at the optimum rate, which we have found to be between25 and 50 cubic centimeters of air per, second when the intrapulmonary pressure is at 20mm. Vof mercury. AThis pressure `has been found be most satisfactory. pI-Ie'retofore such tests have `been made .either through large ori'-V ces, at many ytime'sfthe optimum rate, or when holding'the breath' ,which is at vrate zero.A TheV maximum systolic response` is 'obtained` with small orifices.v l v A With large orices .the emptying of the lungs limits the duration of the blow, and our instru-A ment isV provided `with anl o'riiice allowing 20,0 cc.

of airto flow v per second (at 20mm. pressureV drop). to be used in measuring the vital capacity ofthe lungs.' 'f The maximum length of blow (in the blow, largely mechanical 'in origin. Thev systolic responses withsmallorices, however, are of quite a different nature, being due chiefly to the accumulationl of carbon dioxide and depletionV of oxygen in the blood because the respirationtis suspended; Such slow changes are' obviously better suitedL to precise measurement than the rapid fluctuations in systolic pressure resulting fronrviolentV movements of the thoraxand diaphragm. f Y Y To show the' effect ofthe size of orice upon the maximum systolic response (maximum vminus rest-.'value)during'the longest possible blow at 20 mm. intrapulmonary pressure, the average valuesof :severaltrialsfonV each of five different orifices, covering the entire range of small orifices, have been compared; Twenty normaladult malesugave the averages 16, 24,27, 25 and 13 mm. i 2 mm., respectively, for the orifices havfact may explain the maximum'response, fory at` half-tide the subjectismuscularly at ease, and

so'can concentrate all" his will power toresist the respiratory hormone. When holdingythe breath 'with thelungs fullof ainthe distension Ihe only systolic response with' of the thorax and diaphragm produces muscular fatigue, and this'rprob'ably assists in breaking the, will before the maximum rise in blood-pressure vhas accumulated.' Obviously, the factors which .end the bloware not the same with-small as with large orifices; Indeed, we have found vin a series .ofover one'hundred normal adultsthat the older subjects on thejaverage cannotblow as long as the youngerpnes through the 200 oriforming a compression chamber.

` loss of Vliquid by overilowing.

ce, but on the contrary can blow somewhat longer than the younger ones through the 36 orifice. v v

The apparatus comprises a compression chamber with four openings: (l) into a flexible tube connected with a mouthpiece through which the subject blows; (2) a small orifice which regulates the rate of expiration so that a maximum response in blood pressure is produced; (3) a large orice to permit of a vital capacity measurement;

and (4) into a sensitive manometer to indicate the intrapulmonary pressure. The Volume of air expired is proportional to the time 'at the standard pressure, and this .time vi'sfrnost simply measured by the second-hand of a watch ina manner already familiar to kdoctors in observing the pulse-rate. The blood-pressures are measured as usual by a sphygmomanometer.

The manometer which indicates the intrapulmonary pressure can be of aneroid type, but we prefer the simple water-column, which caribe reproduced exactly to specification, never requires recalibration, and is suiieiently sensitive kwithout being mechanically unreliable. Moreover, as the air expired from the-lungs is saturated Ywith water. vapor, a water manometer is most` appro# priate. The duration of the vblow can be recordedby a pen actuated by the manometerl on a paper disc ortape moved at constant rate by a clock mechanism, but the conditions of medical practice` require the utmost simplicity and portability. VThe doctors watch,v isv already `at hand,`rnost convenient and quite reliable. j The examiner can use his own sphygmornanometer: The mercury 'type of sphygmomanometer possesses the distinct advantage of enabling the exairliner while observing it to glance at the water manometer used to indicate theintrapulmonary pressure without moving his head, when the water manometer is mounted in` front ofk the sub-r ject forjhim to watch.l i

To enable otherstofclearly understand anduse the invention, the invention will be described for l the purpose of illustrationA withjreference' to the accompanying drawing, in which:

Fig. 1 represents a front' elevaticnof the appa-` ratus in partial section; Q

, Fig. 2 represents'a rear elevation of a portion of the apparatus shown inFig; 1;'and v Figs. 3 anda represent two other positions of the two vway valve of Ythe apparatus than that shown inFig. 1. y

VIn the drawing, lis 'a wide mouth glass bottle It isV fitted with a rubber stopper -2 having va metal cap 3 and provided with three holes.

`one of the holes is sued with a tube 4 leading near-ly to the bottom of the chamber and fitted` at its upper end with a valve 5V and a socket 6 adapted to receive the lowerend of.a manometer tubecomprising a lower. metallicportion 7 and anv upper glass portion 8 open at Ythe top to the atmosphere. lfIhe-bulblQ serves to prevent'any -Another Aoi the holes is fitted with'a tube l0 carrying a valve 11. -A rubberjtube l2 is iitted to the upper end of tube 110 and the other end of the rubber tube carries a detachable. mouthpiece 13.Y Y Y .The third lhole isrtted with a tube 14 pro- .vided at its upper end with a two way stopcock -15 adapted to close-the chamber from the exterioras shown inFi'g. l, or to open thechamber to therexterior, through the small orifice 16 asshown in Fig. 3, or through the large orice 1'7 as shown in Fig. 4.

The subject takes the mouthpiece 13 in his right hand and inspiring until his lungs are as full as possible, inserts the mouthpiece into his 'mouth and blowsthrough the rubber tube l2,

the entrance valve l1 (which is open when the lever 18 is horizontal to the right) into the compression chamber 1, thereby forcing the water 19 in the bottom of the compression chamber up the manometer tube 4 until the Water level is at the index mark 2i); Air then escapes from the largeorifice 1'? (when the lever 21 of the two way valve 15 is horizontal to the left) at the constant Yrate of 200 cc. per second until he has expired his maximum. The examiner signals to the subject Inspirel and Blowl at the proper moments' so that the duration of the blow can be accurately and easily measured bythe second-hand of his watch. Three trials are usually sufoientto obtain 'a maximum Ylength or" blow' in seconds which', when multiplied by 0.2,f`givesn a value within 5% of the true vital capacity:

The lever .21 is then turned until horizontal to the right, thus' opening the valve 15 to the small orifice 16. The subject inspires fully againon signal and blows as long as possible through the small orifice at 36 cc. per second, holding the water in the manometer exactly at the index-level (indicating an intrapulmon'ary pressureV of 272 mm. of water, equal to l2() nim'. of mercury). 'In

normal subjects the systolic pressuredrops'considerably below the-rest-value during the first lll-20 seconds of the blow because of the increased intrathoracic pressure with 20 mm. positive intra--r pulmonary pressure, and then rises steadilyto values considerably Vabove the restwalue, at the end ofthe blow. The examiner -iollowsthese changes with the sphygmomanometer cui at` tached to the subjects left arm, and times the various phases. When'anfassistant is available,` the'ex'arniner can concentrate on the pressure loo changes, stating them as they occurto berecordedv by the assistant who also notes the times. v VThe responses in diastolicpressure'andvpulse rate 'canE be followed in a similar manner. yIn normal subjects the diastolic'rises during the initial drop in systolic, then falls somewhat for af few moments before thenal risev which parallels the systolic until the end ofl the vblow'funless the pulsel rate increa'sesas it does somewhatv in nervous subjects toward the end if the blow'is'iprotracted by main force.` The diastolic never continues to riserafter the subject stops blowing, as often happens with the systolic, but drops abruptly and remains below its` rest-valueffor anfappreciable intervalof time, returning gradually 'as the eiTects of the test wear-'oir'. Instead of waiting for this-"return, however, the test is repeated on" a fixed time schedule, which accentuates the re' sponses in successive tests, so that the rest-values progress in a significant'manner- The pulserate is not Vmarkedly accelerated by this test'y as itis by physical exercise, probably because little lactic acid accumulates in the muscles The excess o1' carbon dioxide and lackof oxygen in the 'blood disappear quickly as soon as respiration iseresumed, while after exercise carbon dioxide `con-- tinues in excess until the lactic acid is consumed. We, therefore, believe that the iiarimeter tests will be found to manifest signs of physical impairment diierent from those shown by exercise tests. f The mouthpiece 13 of the flariineter can be of glass or metal, but we prefer pressed paper, a new one for `each subject, yfor sanitary reasons, and o because of their flexibility which relieves muscular fatigue of the lips. The long levers for manipulating the valves are arranged so that the case in which the instrument is protected cannot be closed when the valves are open. The small bulb 9 at the top end of the glass manometer tube 8 prevents the Water from overflowing before the,

subject can adjust his intrapulmonary pressure to the index level. a stainless colorant, but the pressure level is easily seen Without it. The overall height of the aparatus need not exceed 30 cm. whenin opera-1 tion. For convenience, however, We have made the upper glass portion ofthe manometer tube detachable, which reduces the height of the closed case to Veryconvenient proportions for carrying in the doctors bag or even in his pocket.y In the following claims the term variations in blood pressure is intended to include the systolic and diastolic pressures, pulse rate and pulse form.

We claim: 1. A method of testing the physical condition The water can be colored with of human beings which comprises measuring the variations in blood presures of a subject while the lsubject is expiring at a controlled constant rate of from'about 25 to about 50 cc. per second and at a controlled constant intrapulrnonary pressure.

2. A method of testing the physical condition of human beings which comprises measuring the variations in blood pressures of a subject while the subject is expiring at a controlled constant rate of from about 25 to about 50 cc. per second `and. at a controlled constant intrapulmonary 

